Walking cadence (steps/min) during daily activity of patients with chronic obstructive pulmonary disease (COPD) has not been evaluated yet. We aimed to characterise the clinical validity of real-world walking cadence by assessing its levels, variability and relation to clinically relevant characteristics and outcomes in patients with COPD.

We pooled data from two 12-months prospective COPD cohort studies in nine European cities. We measured walking cadence (steps/min) from accelerometer data, clinical and functional characteristics from validated questionnaires and standardised tests, and occurrence of severe exacerbations during follow-up from patient reports and medical registries.

We included 603 participants (20% female), of mean (SD) age 68 (8) years, post-bronchodilator FEV1 57 (19) %, and 6,813 (3,938) steps/day. Mean walking cadence was 88 steps/min and exhibited a normal distribution (SD=9). After adjusting by age, sex and height in multivariable regression models (fractional polynomial, linear, logistic or negative binomial), walking cadence was positively associated with FEV1, 6-min walk distance, physical activity, physical activity experience and health-related quality of life; and negatively associated with breathlessness and depression (all p<0.05). These associations remained after further adjustment by daily steps. Walking cadence was inversely associated with the number of severe exacerbations during follow-up (adjusted IRR=0.95 per step/min, 95%CI 0.91-0.99, p=0.013).

Higher real-world walking cadence is associated with lower COPD severity as defined by many relevant outcomes, which makes it reliable as a prognostic marker and, ultimately, an outcome measure for clinical trials.